Disability is a major problem facing the aging US population. Use of assistive technology (AT), like canes, walkers and wheelchairs, is a common and apparently effective way of coping with disability. However, there are some problems with AT use in the older population, including patient acceptance, ill fit, incorrect use, and disrepair. AT aids can be obtained with varying degrees of professional consultation, ranging from patient self-selection to extensive consultation with an expert clinician or therapist. It is thought that expert consultation to custom fit and train the user may reduce the problems and improve the benefits associated with use of AT, but surprisingly this has not been adequately investigated. Professional consultation is costly and time consuming, so determining which forms of consultation provide the most benefit is important. In this study we propose to use wheelchairs as model AT and examine if varying degrees of professional consultation affect the outcome of wheelchair use. Our specific aims are to: (1) To codify an improved method for fitting and training wheelchair users that incorporates (a) assessment of physical impairments and internal and external barriers to wheelchair use; (b) individualization of the wheelchair based on the assessment; and (c) implementation of interventions to reduce barriers to wheelchair use; and (d) follow-up to address unexpected problems. (2) To determine the efficacy of the new method compared to a less intensive method, examining effects on community mobility, independence in self-care, and quality of life. (3) To disseminate information on the merits of differing methods for providing wheelchairs to consumers, wheelchair suppliers, and clinicians. (4) To determine factors necessary for implementation of a multi-site, randomized controlled trial of alternative methods for providing wheelchairs in the general population.